Abstract 2668: A Prospective, Randomized Evaluation of Intraaortic Balloon Counterpulsation for the Prevention of Multiorgan-Dysfunction and -Failure in Patients with Acute Myocardial Infarction complicated by Cardiogenic Shock
Objectives. In patients with myocardial infarction complicated by cardiogenic shock (MI-CS) the use of IABP is part of the standard regimen. No randomized clinical trial has yet proven whether IABP improves the unfavourable prognosis which is determined not only by deterioration of cardiac function but also by development of multiorgan dysfunction syndrome (MODS). The IABP-shock-trial was conducted as a randomized and prospective trial with two arms and parallel design to determine the role of IABP for the prevention or reduction of MODS in PCI-treated patients with MI-CS. Primary end point of the study was the fall in APACHE II score - a severity of disease score - from day 0 to day 4 indicating improvement of MODS.
Methods. 40 patients with MI-CS and treated within 12 h of onset of hemodynamic instability were included in the study (31 males, 9 female, mean age 64 ± 1,9 yrs., 28-day survivors 27/40; CI day 0: 2,52 ± 0,15 l/min/m2, day 4: 3,17 ± 0,39 l/min/m2; duration of IABP application: 44 ± 8,2h). Initial and serial APACHE II scoring 24, 48, 72 and 96 hours after starting randomization was carried out.
Results. Initial and serial APACHE II scoring could be prospectively identified as valuable prognostic markers with a strong fall of APACHE II score from day 0 to day 4 in survivors indicating a favourable prognosis (survivors: Δ-4,2; non-survivors: Δ+ 0,7). With respect to the study groups, only minor differences could be observed (IABP: Δ-2.8; non-IABP: Δ-2,5).
Conclusions. The use of IABP was unable to improve severity of disease (MODS) in patients with MI-CS within the first 4 days. Consequently no beneficial effect of IABP on development and progression of MODS could be documented.